Epidemiology, Risk Factors, and Clinical Outcomes of AKI in Pediatric Hematopoietic Stem Cell Transplant Patients

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Statistical Analysis:
Measures of association were used to determine risk difference with associated 95% confidence intervals (95% CI).
Competing risks analysis was used to illustrate likelihood of experiencing mutually exclusive outcomes by calculating Cumulative Incidence at End of Time Window and Aalen-Johansen curve using the R Survival library, version 3.2-3.The competing risks analysis evaluated risk factors independently using an Aalen-Johansen estimator which reduces to the Kaplan-Meier estimator to determine cumulative incidence.Cox proportional hazards regression analysis was used to compare time-to-event rates in matched cohorts.Kaplan-Meier analysis was used to estimate the survival probability of given clinical outcomes.Hazard ratio (HR) and associated 95% CI were calculated using R's Survival package, version 3.2-3.The incidence proportion of dialysis requirement (CPT codes: 1012740, 1029674 90945, 90947; Systemized Nomenclature of Medicine code: 108241001; ICD-10 code: Z99.2) was defined as the rate of new cases of interest divided by the number of patients who do not have the event of interest during the given time window annually.Prevalence rate was defined as the rate of all cases recorded within the lookback period.Significance tests were 2-sided, paired, and statistical significance was set at p < .05.

Table 1 .
Covariates used for propensity score matching

Table 2 .
Hazard ratios of transplant-related risk factors

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Hazard ratios of transplant-related risk factors calculated from Cox proportional hazards model.Encounter diagnosis of graft-versus-host disease was shown to incur the greatest hazard rate.

Table 3 .
Hazard ratios of clinical outcomes at 90-, 180-, and 365-day intervals ED: emergency department; ICU: intensive care unit.Hazard ratios were calculated from Cox proportional hazards model.Supplemental

Table 4 .
Current Procedural Terminology (CPT) codes utilized to quantify severity of clinical outcomes Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity.Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs.Usually, the problem(s) requiring admission are of low severity.Typically, 30 minutes are spent at the bedside and on the patient's hospital floor or unit.: Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity.Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs.Usually, the patient is responding inadequately to therapy or has developed a minor complication.Typically, 25 minutes are spent at the bedside and on the patient's hospital floor or unit.99226: Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity.Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs.Usually, the patient is unstable or has developed a significant complication or a significant new problem.Typically, 35 minutes are spent at the bedside and on the patient's hospital floor or unit.99231: Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Medical decision making that is straightforward or of low complexity.Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs.Usually, the patient is stable, recovering or improving.Respiratory Ventilation, Greater than 96 Consecutive Hours 5A09357: Respiratory Ventilation, Less than 24 Consecutive Hours 0BH13EZ: Insertion of Endotracheal Airway into Trachea, Percutaneous Approach 0BH17EZ: Insertion of Endotracheal Airway into Trachea, Via Natural or Artificial Opening 0BH18EZ: Insertion of Endotracheal Airway into Trachea, Via Natural or Artificial Opening Endoscopic 99222: Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity.Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs.Usually, the problem(s) requiring admission are of moderate severity.Typically, 50 minutes are spent at the bedside family's needs.Usually, the patient is stable, recovering, or improving.Typically, 15 minutes are spent at the bedside and on the patient's hospital floor or unit.99225Supplemental Figure 1.Propensity Score Density Function 1:1 propensity score matching was conducted using a greedy nearest-neighbor matching algorithm with an arbitrary tolerance level set at 0.1.Purple indicates AKI patients and green indicates non-AKI patients.